PPT 7 ET/Depression Flashcards
What is depression?
Common and serious illness that negatively affects how you feel, the way you think and how you act
DSM-V criteria for major depression. Main plus 4+ symptoms
1- depressed mood and or uninterested in activities
2- symptoms: weight gain or loss, insomnia/hyper, psychomotor retardation/agitation, fatigue, feeling of guilt, reduced concentration, suicidal ideas
% of global annual incidence of MDD
3%
Lifetime incidence of MDD
15-20%
% of adolescents will have diagnosis of depression by the age of 18
11%
Does risk for depression increases with age
yes
what is the third leading cause of death among adolescents
suicide
is MDD a leading cause of illness and disability across all ages
yes
women or men have higher rates of depression
women
women 18-24 have x amount higher depression than men
3x
is depression more prevalent in people with chronic disease
yes
Canada: is ? higher in chronic disease population compared to general population (~5%)
two- to threefold
4 categories of non communicable diseases
what is the % worldwide of death and in canada
1- cvd
2- diabetes
3- chronic resp disease
4- cancer
- 70%
- 64% canada
4 things that cause depression
1- inflammation
2- genetic
3- neurochemical
4- life experiences
1- inflammation 4 traits
heat
pain
swelling
redness
Individuals living with depression typically tend to exhibit higher OR lower levels of the pro-inflammatory cytokines compared to non-depressed individuals
higher
2- Genetics: is there a gene
no
3- Neurochemical is what, list 3 NT
problems or imbalances in the brain, specifically with the NT:
- serotonin,
- norepinephrine,
- dopamine
4- Life Experiences describe + ex like divorce etc.
Major stressful event can contribute to development of depression
Divorce, being bullied, financial difficulties, death of a child or other family member.
2 ways to treat depression
1- Pharmacotherapy
2- Psychotherapy- Cognitive-behavioural therapy
Issues with Pharmacotherapy 5
1- Individual variability from person-to-person
2-Many side effects (e.g. bleeding, seizure)
3-Low adherence rate
4-Cost of treatment
5-Low perception of effectiveness among patients
Issues with Psychotherapy- Cognitive-behavioural therapy 2
1- Accessibility issues
2- Costs
Name some benefits of ET
1- Maintains healthy weight 2- Improves cardiorespiratory capacity 3- Improves sleep 4- Beneficial effects on physical health 5- Improves quality of life 6- Improves + mood 7- Promotes social integration 8-Increases energy 9-Reduces stress levels
3 benefits on physical health
1-Reduces risk of mortality in CVD
2-Reduces dyspnea in COPD/Asthma
3-Improves survival in cancer
Benefits of exercise Regarding depression
4
Exercise is related to positive changes in mood state
Less (if none) negative side effects than antidepressants
May reduce the negative side effects of antidepressants (e.g. constipation)
Inexpensive treatment
Exercise and depression in adults greater in older or younger
older
Long-term effect of ET
small effect in favour of exercise
clear dose–response relationship overall?
no
Even infrequent participation in exercise (e.g. 1–2 days/week) is associated with reduced likelihood of depression
is ET able to decrease depressive symptoms in people with chronic disease
yes
Name gaps in the literature for chronic illness and ET.
3 (focused, few studies and no ? reviews)
1- focus on multi-component interventions but just ET
2- Few studies has assessed the relationship between exercise and depression in patients with asthma and type 2 diabetes (T2D)
3- No systematic reviews have examined specifically the role of aerobic exercise on depressive symptoms in NCDs
What was her thesis
Assess the efficacy of aerobic exercise on depressive symptoms in people living with a NCD compared to no treatment (i.e. usual care).
What was the type of study
Type of study: Systematic review and meta-analysis
What is a systematic review?
Literature review designed to synthesize all empirical evidence relating to a clearly formulated research question
What does a systematic review identify, appraises and summarizes?
Identifies relevant studies, appraises their quality and summarizes the evidence through explicit methodology
What kind of answers does a systematic review provide
Provides informative and evidence-based answers
List the type of studies from low evidence to high 9
1- background info 2- individual case reports 3- case series or studies 4- cohort 5- non randomized controlled trials 6- randomized controlled trials 7- critically appraised literature 8- systematic review 9- meta analysis
8 procedure steps of systemic review
1-Develop research question (Population, Intervention, Control, Outcome) 2-Develop search strategy 3-Contact research librarian 4-Literature search 5-Data extraction 6-Data analysis 7-Interpretation of findings 8-Writing & editing for publication
Define the PICOS of the study
P: Adults living with a NCD
I: Aerobic exercise intervention;
C: No exercise (usual care)
O: Reduction in depressive symptoms or depression
What was the aerobic exercise intervention criteria.
Intensity and time
Moderate intensity (> 50% HRT), at least twice a week, 4 weeks
Her main question was can aerobic…
Can an aerobic exercise intervention, compared to no exercise, reduce depressive symptoms in adults living with a NCD?
Type of study what was the:
intervention
language
published date
- randomized/non
- english or french
- studies published until june 29th 2017
What was the chosen population
age above 18
living with NCD
What was the intervention
aerobic exercise
Name some data analysis methods that were used. 4
1- standardized difference in means
2- random effects model
3- funnel plot
4- Cochran’s Q and Higgings I2 test
Subgroup analyses performed according to. 4
1- # days of training
2- duration of sessions
3- length of intervention
4- type of NCD
standardized difference in means effect ranges
small: 0.2-0.5
med: 0.5 - 0.8
large: 0.8 and higher
Results: how many participants and their age
4111 age 34-70
Results intervention criteria:
frequency training
time of session
length of program
frequency: 2 and 5 sessions/week
Time: 20 and 80 mins
Length: 4 and 24 weeks
What were the two limitations
1- lack of homogeneity across studies
2- Usual care may not have been similar across studies and NCDs
What were the two strengths
1- Thorough search methods
2-Studies different on several levels (patient populations, quality…)
lack of homogeneity was driven from what
driven by some large effect sizes and small sample sizes
lack of homogeneity reduces what
Reduces clinical impact of findings
Usual care may not have been similar across studies and NCDs. Attempts to reduce what
Attempt to reduce disparities using inclusion/exclusion criteria
Studies different on several levels (patient populations, quality…) increases?
Increases generalizability of findings
what was the conclusion
Overall, aerobic exercise more efficacious than usual care. Most efficacious in CVD
are Length of intervention, number of days and duration key factors
no
What are the NICE ET guidelines
45-60 minutes/session
3 sessions per week
12 weeks
What are the potential mechanisms explaining a link between exercise and depression?
1- Physiological
2- psychological
What are the 3 - Physiological hypothesis
1-Monoamine hypothesis
2-Inflammation hypothesis
3-Endorphin hypothesis
Explain the monoamine hypothesis
Exercise increases the availability of brain neurotransmitters
monoamine hypothesis studies are conducted on who
animals. unknown if applicable to human brain
2-Inflammation hypothesis
Individuals with depression have elevated concentrations of pro-inflammatory biomarkers
Exercise has been shown to reduce these biomarkers.
3-Endorphin hypothesis
Exercise leads to surge of endorphins
Reduce pain and provide state of euphoria
Do endorphins directly alter mood state or indirectly facilitate improved mood through energy conservation during exercise
it is unclear
Can euphoria state can be experienced at low level of intensity
yes
Is High intensity level of exercise required to release endorphin
yes
4- Psychological mechanisms
1-Distraction hypothesis
2-Self-efficacy theory
3-Mastery hypothesis
4-Social interaction
1-Distraction hypothesis
Diversion from unpleasant stimuli or painful somatic complaints leads to improved affect following exercise
Distraction hypothesis: support for long term effect?
no
2-Self-Efficacy Theory
Level of confidence that one feels it possesses to meet the challenge at hand
Confidence in one’s ability to exercise is strongly related to one’s actual ability to perform the behavior
Individual with high self-efficacy for exercise are more likely to exercise
yes or no
yes
Mastery Hypothesis
Mere fact of exercising can make patients feel like they have achieved something
Mastery Hypothesis mediator between
PE and QOL
Social Interaction Theory
Social relationships and mutual support provided to one another by co-exercisers might account for antidepressant effects
Social Interaction Theory results
mixed, Could be more important for older people
4 Limitations of current studies 1- gap in 2- lack of studies 3- most studies do not 4- Most studies dont look at whether exercise can..
Gaps in litterature regarding long-term effects of exercise
Lack of studies looking at potential mechanisms
Most studies do not assess for clinical depression
Most studies do not look at whether exercise can treat clinical depression
4 reasons why good quality research is lacking
1-Not always a distinction between PA and PE (except in intervention studies)
2- Few studies intent-to-treat
3-Not always including a control group
4-Usually targeting low/mild depression
Overall conclusion about ET
it provides moderate benefits
What exercise is a good treatment of mild to moderate depression
Both high & low-dose aerobic exercise
True or False: Exercising 3 times per week is at least as effective as 5 times per week
true
Exercise therapy should be done by what person
qualified professionals
True or false: encourage exercise as an adjunct to other forms of therapy
true
should FITT be common or individualized
individualized
In future: RCTs should include 2 things
allocation concealment
Intent-to-treat analysis
In future: studies should compare what
exercise and other alternative treatment to depression (e.g. music therapy)
should there be a Systematic follow-up to see effect on long-term on depression and adherence to exercise
yes
